Postoperative nausea and vomiting: A simple yet complex problem

Abstract

Postoperative nausea and vomiting (PONV) is one of the complex and significant problems in anesthesia practice, with growing trend toward ambulatory and day care surgeries. This review focuses on pathophysiology, pharmacological prophylaxis, and rescue therapy for PONV. We searched the Medline and PubMed database for articles published in English from 1991 to 2014 while writing this review using “postoperative nausea and vomiting, PONV, nausea-vomiting, PONV prophylaxis, and rescue” as keywords. PONV is influenced by multiple factors which are related to the patient, surgery, and pre-, intra-, and post-operative anesthesia factors. The risk of PONV can be assessed using a scoring system such as Apfel simplified scoring system which is based on four independent risk predictors. PONV prophylaxis is administered to patients with medium and high risks based on this scoring system. Newer drugs such as neurokinin-1 receptor antagonist (aprepitant) are used along with serotonin (5-hydroxytryptamine subtype 3) receptor antagonist, corticosteroids, anticholinergics, antihistaminics, and butyrophenones for PONV prophylaxis. Combination of drugs from different classes with different mechanism of action are administered for optimized efficacy in adults with moderate risk for PONV. Multimodal approach with combination of pharmacological and nonpharmacological prophylaxis along with interventions that reduce baseline risk is employed in patients with high PONV risk.

Comparison of the effects of desflurane and total intravenous anesthesia on the optic nerve sheath diameter in robot assisted laparoscopic radical prostatectomy

“…[ 17 ] Elevated ICP is also 1 of the risk factors for PONV. [ 18 ] Based on the results of this study, we can expect that TIVA will decrease the elevation of ICP compared to volatile agents and reduce the incidence of PONV in RALP. Additional study is required to elucidate the effects of increased intracranial pressure on PONV in RALP patients.…”

Prospective investigation of intravenous patient-controlled analgesia with hydromorphone or sufentanil: impact on mood, opioid adverse effects, and recovery

“…The Apfel simplified risk score is based on four predictors: female, history of PONV and/or motion sickness, nonsmoking status, and use of postoperative opioids [ 33 ]. Roberts et al and Shaikh et al demonstrated that postoperative opioids increased risk for PONV [ 34 , 35 ]. Therefore, we speculate that the signifcant difference in the incidence of nausea between the two groups may result from the different opioid with IV-PCA.…”

Patient's Experiences and Difficulties at Home Following Day Surgery

“…nonpharmacological prophylaxis along with interventions that reduce baseline risk is employed in patients with high PONV risk. [20][21][22] Several studies in the literature report that inability of patients in respect of maintaining their selfcare at home after an outpatient operation is one of the disadvantages of this type of surgical intervention. 2,7,18 In respect of the daily life activities within the first 24 hours in the post-surgery period, our study found that patients had difficulty in walking and moving around, going up the stairs, in meeting their needs with respect to self-care, bathing and dressing-undressing (Table 3).…”